Exam-exhaustive topics, MCQs, SAQs, vivas, cases, timed exams, spaced review and videos for the fellowship you are sitting — every clinical claim cited to PubMed and checked against its source before it earns the badge.
Severe chest tube bleeding (over 300 mL in the first hour, over 200 in the second, over 100 in the third) OR sudden CESSATION of drainage with haemodynamic collapse = attributable harm or clotted-tube tamponade → early URGENT RE-EXPLORATION (within 4 hours is safest)
Post-CPB vasoplegic syndrome: MAP under 65 despite fluid and catecholamines with a normal or high cardiac index and low SVR = NO-mediated vasoplegia → noradrenaline first, vasopressin 0.01-0.06 U/min, methylene blue 2 mg/kg IV for refractory
Every clinical claim carries its source — and someone checked it.
01
Gather, never generate
No clinical sentence is written from memory. Every claim is assembled from a live-fetched source — a PubMed abstract or the governing guideline — and the reference’s PMID must resolve, live, to the same paper by title, authors and year.
02
An independent check
Whoever writes a page never signs it off. A reviewer who has not seen the writer’s reasoning re-checks every dose, threshold, criterion and trial result against its cited source, and a mechanical diff proves no number changed. A claim that cannot be sourced is deleted, not improved into plausibility.
03
The stamp
A page that passes is recorded in the verification ledger with its review date. The badge on every page reads that ledger — generated, never hand-set — and a page still in the queue says so.
A 60-year-old man presents with central crushing chest pain for 2 hours, sweating, and nausea. ECG shows ST elevation in leads II, III, aVF. What is the diagnosis and what is the most urgent management?
ANSTEMI - medical management
BSTEMI (inferior) - emergency PCI within 120 minutes (or thrombolysis if PCI unavailable)
CUnstable angina - aspirin and observe
DPericarditis - NSAIDs
EAortic dissection - CT scan
Why — ST ELEVATION in leads II, III, aVF = INFERIOR STEMI (right coronary artery territory). This is a complete coronary occlusion requiring IMMEDIATE REPERFUSION. First-line: PRIMARY PCI within 120 minutes of first medical contact (door-to-balloon time). If PCI not available within 120 minutes: THROMBOLYSIS (alteplase/tenecteplase within 12 hours of symptom onset). Also give: aspirin 300mg, ticagrelor/clopidogrel loading, heparin, nitrate (if BP adequate), oxygen (if hypoxic), morphine (if pain unresponsive), statin. The ECG is diagnostic: ST elevation in contiguous leads confirms STEMI.
A 72-year-old woman arrives in septic shock from urosepsis. She has received 30 mL/kg of 0.9% saline in the ED — 1.8 L. She remains hypotensive (MAP 59), lactate 3.8, warm peripheries. Her chloride is 112, pH 7.28, base excess minus 6. The registrar wants to give another litre of saline.[14]
Two questions frame every fluid decision in the ICU: which fluid? (balanced crystalloid first-line; saline causes hyperchloraemic acidosis and AKI) and how much? (only about half of ICU patients are fluid responsive — test before every bolus). Get those two right and you avoid the commonest iatrogenic harm in intensive care.[14][15]
References5ShowHide
[1]Malbrain MLNG, Van Regenmortel N, Saugel B, et al. Principles of fluid management and stewardship in septic shock: it is time to consider the four D's and the four phases of fluid therapy Ann Intensive Care, 2018.PMID 29789983
[13]Semler MW, Self WH, Wanderer JP, et al. Balanced Crystalloids versus Saline in Critically Ill Adults N Engl J Med, 2018.PMID 29485925
[14]Evans L, Rhodes A, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 Intensive Care Med, 2021.PMID 34599691
[15]Marik PE, Cavallazzi R Does the central venous pressure predict fluid responsiveness? An updated meta-analysis and a plea for some common sense Crit Care Med, 2013.PMID 23774337
[21]Myburgh J, Cooper DJ, Finfer S, et al. Saline or albumin for fluid resuscitation in patients with traumatic brain injury N Engl J Med, 2007.PMID 17761591
Every clinical claim on that page — doses, thresholds, named criteria, trial results, guideline recommendations — was checked against its cited PubMed source, fetched live, by a reviewer independent of the writer, and the page was recorded in the verification ledger with its review date. A page still in the queue shows “Verification in progress” instead. Editorial policy →
02What is free?
The first section of every topic, the source-verified register, the editorial policy and every lecture video are free to read. Specialty Pro unlocks the complete atlas, exam formats and synchronised review for one fellowship specialty chosen at checkout. Pricing →
03Can I cancel?
Yes. Cancellation takes effect at the end of the current paid period, through the Stripe billing portal. Cancelling never deletes your study history. Terms →
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